Health & insurance

As long as you stay up to date with your vaccinations and take some basic preventive measures, you'd have to be pretty unlucky to encounter any serious health hazards in Réunion. The island has a fair selection of tropical diseases on offer, but you're much more likely to get a bout of diarrhoea or a sprained ankle than an exotic disease.

Chikungunya epidemics have been an issue in Réunion in the past, so check the latest before travelling.

Before You Go

Planning

A little planning before departure, particularly for preexisting illnesses, will save you a lot of trouble later. Before a long trip, get a check-up from your dentist and your doctor if you require regular medication or have a chronic illness, eg high blood pressure or asthma. You should also organise spare contact lenses and glasses (and take your optical prescription with you); get a first-aid and medical kit together; and arrange necessary vaccinations.

Travellers can register with the International Association for Medical Assistance to Travellers (www.iamat.org). Its website can help travellers find a doctor who has recognised training. You might also consider doing a first-aid course (contact the Red Cross or St John Ambulance) or attending a remote medicine first-aid course, such as that offered by the Royal Geographical Society (www.wildernessmedicaltraining.co.uk), although in Réunion you're never far from help.

If you are bringing medications with you, carry them in their original containers, clearly labelled. A signed and dated letter from your physician describing all medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity.

Recommended Vaccinations

The World Health Organization (www.who.int/en) recommends that all travellers be adequately covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as for hepatitis B, regardless of their travel destination.

Although no vaccinations are officially required, many doctors recommend hepatitis A and B immunisations; a yellow-fever certificate is an entry requirement if travelling from an infected region.

Health Insurance

Find out in advance whether your insurance plan will make payments directly to providers or will reimburse you later for health expenditures (in many countries doctors expect payment in cash). It is vital to ensure that your travel insurance will cover outdoor activities, including paragliding, diving and canyoning, as well as the emergency transport required to get you to a good hospital, or all the way home, by air and with a medical attendant if necessary. Not all insurance policies cover this, so be sure to check the contract carefully. If you need medical care, your insurance company may be able to help locate the nearest hospital or clinic, or ask at your hotel. In an emergency, contact your embassy or consulate.

Medical Checklist

It is a good idea to carry a medical and first-aid kit with you, in case of minor illness or injury. Following is a list of items you should consider packing.

Websites

There is a wealth of travel health advice available on the internet – www.lonelyplanet.com is a good place to start. The World Health Organization publishes a superb book called International Travel and Health, which is revised annually and is available online for free at www.who.int/ith. The following are other health-related websites of general interest:

Centers for Disease Control and Prevention (www.cdc.gov)

Fit for Travel (www.fitfortravel.scot.nhs.uk)

MD Travel Health (https://redplanet.travel/mdtravelhealth)

You may also like to consult your government's travel-health website, if one is available:

Australia (https://smartraveller.gov.au/guide/all-travellers/health/)

Canada (www.phac-aspc.gc.ca)

USA (www.cdc.gov/travel)

In Réunion

Availability & Cost of Health Care

Health care in Réunion is generally excellent. Public hospitals offer the cheapest service, but may not have the most up-to-date equipment and medications; private hospitals and clinics are more expensive but tend to have more advanced drugs and equipment and better-trained medical staff.

Infectious Diseases

It's a formidable list, but a few precautions go a long way.

Chikungunya

This viral infection transmitted by certain mosquito bites was traditionally rare in the Indian Ocean until 2005 when an epidemic hit Réunion, Mauritius and the Seychelles. The unusual name means 'that which bends up' in the East African language of Makonde, a reference to the joint pain and physical distortions it creates in sufferers. Chikungunya virus is rarely fatal, but it can be, and it's always unpleasant. Symptoms are often flu-like, with joint pain, high fever and body rashes being the most common.

It's important not to confuse it with dengue fever. If you're diagnosed with Chikungunya virus expect to be down for at least a week, possibly longer. The joint pain can be horrendous and there is no treatment; those infected need simply to rest inside (preferably under a mosquito net to prevent reinfection), taking gentle exercise to avoid joints stiffening unbearably. The best way to avoid it is to avoid mosquito bites, so bring plenty of repellent, use the anti-mosquito plug-ins wherever you can and bring a mosquito net if you're really thorough.

Dengue Fever

Dengue fever reappeared in Réunion in 2018, with more than 6000 people infected. It's a particular concern in urban areas, especially after heavy rains and anywhere with standing or stagnant water. Mosquitoes that carry the virus are active from dawn until dusk.

Dengue fever, spread via mosquito bites, causes a feverish illness with headache and muscle pains similar to those experienced with a bad, prolonged attack of influenza. There might be a rash. Mosquito bites should be avoided whenever possible. Self-treatment: paracetamol and rest.

Hepatitis A

Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy and delayed recovery. If you've had hepatitis A, you shouldn't drink alcohol for up to six months afterwards, but once you've recovered, there won't be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine (Hepatyrix or Viatim).

Hepatitis B

Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It can also be passed from an infected mother to the baby during childbirth. It affects the liver, causing jaundice and occasionally liver failure. Most people recover completely, but some people might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for extended periods or those with increased social or occupational risk should be immunised. Many countries now routinely include hepatitis B as part of routine childhood vaccinations. It is given singly or can be given at the same time as hepatitis A (Hepatyrix). A course will give protection for at least five years. It can be given over four weeks or six months.

Leptospirosis

Cases of leptospirosis have been reported in Réunion. It spreads through the excreta of infected rodents, especially rats. It can cause hepatitis and renal failure, which might be fatal. Symptoms include flu-like fever, headaches, muscle aches and red eyes, among others. Avoid swimming or walking in stagnant waters.

Malaria

The risk of malaria in Réunion is extremely low.

Rabies

Rabies is spread by receiving the bites or licks of an infected animal on broken skin. The risk here is mainly from dogs. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so post-bite vaccination should be given as soon as possible. Post-bite vaccination (whether or not you've been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Three preventive injections are needed over a month. If you have not been vaccinated, you will need a course of five injections starting 24 hours after being bitten or as soon as possible after the injury. If you have been vaccinated, you will need fewer post-bite injections, and have more time to seek medical help.

Travellers' Diarrhoea

Although it's not inevitable that you will get diarrhoea while travelling in the region, it's certainly possible. Sometimes dietary changes, such as increased spices or oils, are the cause. To avoid diarrhoea, only eat fresh fruits or vegetables if cooked or peeled, and be wary of dairy products that might contain unpasteurised milk. Although freshly cooked food can often be a safe option, plates or serving utensils might be dirty, so you should be highly selective when eating food from street vendors (make sure that cooked food is piping hot all the way through).

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing water (lots), and some salt and sugar. A few loose stools don't require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin) and an antidiarrhoeal agent (such as loperamide) if you are not within easy reach of a toilet. However, if diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.

Yellow Fever

Although yellow fever is not a problem in Réunion, travellers should still carry a certificate as evidence of vaccination if they have recently been in an infected country. For a list of these countries, visit the websites of the World Health Organization (www.who.int/ith) or the Centers for Disease Control and Prevention (www.cdc.gov). A traveller without a legally required, up-to-date certificate may be vaccinated and detained in isolation at the place of entry for up to 10 days or possibly repatriated.

Environmental Hazards

Heat Exhaustion

This condition occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water to produce pale, diluted urine. Self-treatment is by fluid replacement with water and/or fruit juice, and cooling by cold water and fans. The treatment of the salt-loss component consists of consuming salty fluids as in soup, and adding a little more table salt to foods than usual.

Heatstroke

Heat exhaustion is a precursor to the much more serious condition of heatstroke. In this case there is damage to the sweating mechanism, with an excessive rise in body temperature; irrational and hyperactive behaviour; and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement is usually also required by intravenous drip.

Insect Bites & Stings

Mosquitoes in the region can carry chikungunya virus and dengue fever, plus they (and other insects) can cause irritation and infected bites. To avoid these, take the same precautions as you would for avoiding malaria, including wearing long pants and long-sleeved shirts, using mosquito repellent, avoiding highly scented perfumes or aftershaves, etc. Bee and wasp stings cause major problems only to those who have a severe allergy to the stings (anaphylaxis), in which case carry an adrenaline (epinephrine) injection.

Leeches may be present in damp rainforest conditions; they attach themselves to your skin to suck your blood. Salt or a lighted cigarette end will make them fall off. Ticks can cause skin infections and other more serious diseases. If a tick is found attached, press down around the tick's head with tweezers, grab the head and gently pull upwards.

Marine Life

A number of Indian Ocean species are poisonous or may sting or bite. Watch out above all for sea urchins. Other far rarer creatures to look out for include the gaudy lionfish with its poisonous spined fins, and the cleverly camouflaged – and exceptionally poisonous – stonefish, which lives camouflaged amid coral formations. Some shells, such as the cone shell, can fire out a deadly poisonous barb. The species of fire coral, which looks like yellowish brush-like coral growths, packs a powerful sting if touched.

Shark attacks on surfers have been a major issue in Réunion, especially off Boucan Canot, St-Gilles-les-Bains, Trois Bassins and Étang-Salé-les-Bains. Stick to supervised and protected beaches.

Diving Health & Safety

Health Requirements

Officially, a doctor should check you over before you do a course, and fill out a form full of diving health questions. In practice, most dive schools will let you dive or do a course if you complete a medical questionnaire, but the check-up is still a good idea. This is especially so if you have any problem at all with your breathing, ears or sinuses. If you are an asthmatic, have any other chronic breathing difficulties or any inner-ear problems, you shouldn't do any scuba diving.

A simple medical certificate is compulsory for diving in Réunion (but not for introductory dives). You can get one from your doctor in your home country or have it emailed to the dive centre. Otherwise, you can get one from any doctor in Réunion.

Decompression Sickness

This is a very serious condition – usually, though not always, associated with diver error. The most common symptoms are unusual fatigue or weakness; skin itch; pain in the arms, legs (joints or mid-limbs) or torso; dizziness and vertigo; local numbness, tingling or paralysis; and shortness of breath.

The most common causes of decompression sickness (or the 'bends' as it is commonly known) are diving too deep, staying at depth for too long or ascending too quickly. This results in nitrogen coming out of solution in the blood and forming bubbles, most commonly in the bones and particularly in the joints or in weak spots such as healed fractured sites.

Note that your last dive should be completed 24 hours before flying in order to minimise the risk of residual nitrogen in the blood that can cause decompression injury.

The only treatment for decompression sickness is to put the patient into a recompression chamber. There are recompression chambers in Réunion.

Insurance

In addition to normal travel insurance, it's a very good idea to take out specific diving cover, which will pay for evacuation to a recompression facility and the cost of hyperbaric treatment in a chamber. Divers Alert Network (www.diversalertnetwork.org) is a nonprofit diving-safety organisation. It provides a policy that covers evacuation and recompression.

Tap Water

As a general rule, the tap water in Réunion is safe to drink, but always take care immediately after a cyclone or cyclonic storm as mains water supplies can become contaminated by dead animals and other debris washed into the system. Never drink from streams as this might put you at risk of waterborne diseases.

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